Medical University of Vienna, Vienna, Austria.
Pain Physician. 2013 Nov-Dec;16(6):593-601.
The use of opioid analgesics in the treatment of chronic pain conditions has long been controversial. They have been reported to be relatively safe when prescribed with caution, but a brief and valid instrument to estimate a person's risk of addiction is still missing.
The aim of this study was to investigate a self-rating questionnaire allowing an estimation of a person's risk of addiction to opioid analgesics.
Retrospective review.
Four Austrian hospitals.
Seven hundred forty-one patients were interviewed. Of these, 634 patients were affected with chronic pain while 107 patients had a history of opioid addiction. Patients were interviewed about alcohol and nicotine consumption and family history of psychiatric disorders. Attitudes towards medication and the origin of pain were examined. We asked patients with an opioid addiction and patients suffering from chronic pain to complete a short questionnaire intended to help screen for addiction potential.
Compared to the patients suffering from chronic pain, patients with an opioid addiction significantly more often had alcohol- and nicotine-related pathologies and psychiatric comorbidity. A family history of mental illness and developmental problems were significantly more frequent in this group. Compared to those not addicted, those with an opioid addiction had significantly higher expectations concerning the potential of medication to change one's mental state; they thought that psychological factors might contribute to the pain they feel.
The main limitation of this study is the use of a self-rating instrument which reduces objectivity and introduces the possibility of misreporting. Also, the 2 groups differ in number and are not homogenous.
We found differences in questionnaire responses between patients with an opioid addiction and patients suffering from chronic pain to be dependent upon the prevalence of current or former addiction, psychiatric history, attitudes towards medication, and ideas about the origin of pain. We believe these factors have predictive value in estimating a patient with pain's risk of addiction.
在治疗慢性疼痛病症时使用阿片类镇痛药一直存在争议。有报道称，在谨慎使用的情况下，它们相对安全，但仍缺乏一种简短且有效的工具来评估一个人成瘾的风险。
本研究旨在调查一种自评问卷，以评估一个人对阿片类镇痛药成瘾的风险。
回顾性研究。
奥地利的四家医院。
对 741 名患者进行了访谈。其中，634 名患者患有慢性疼痛，107 名患者有阿片类药物成瘾史。患者被询问了酒精和尼古丁的消耗以及精神疾病家族史。检查了对药物的态度和疼痛的起源。我们要求有阿片类药物成瘾和慢性疼痛的患者完成一份简短的问卷，旨在帮助筛查成瘾潜力。
与患有慢性疼痛的患者相比，有阿片类药物成瘾的患者更常患有与酒精和尼古丁相关的疾病和精神共病。该组患者的精神疾病家族史和发育问题明显更为频繁。与没有成瘾的患者相比，有阿片类药物成瘾的患者对药物改变精神状态的潜力有更高的期望；他们认为心理因素可能导致他们感到疼痛。
本研究的主要局限性在于使用自评工具，这降低了客观性并引入了错误报告的可能性。此外，两组在数量上存在差异，且不具有同质性。
我们发现，有阿片类药物成瘾和慢性疼痛的患者在问卷回答上的差异取决于当前或过去成瘾的流行率、精神病史、对药物的态度以及对疼痛起源的看法。我们相信这些因素在估计疼痛患者的成瘾风险方面具有预测价值。
